Bottom Line:
A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation.Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes.SES did not modify the effects of price minimizing behaviors on cessation outcomes.

ABSTRACTThis paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups.

f1-ijerph-08-01671: Modified Compensatory Model of Price effects in response to a price or tax increase.

Mentions:
In addition to the intended cessation outcomes associated with price or tax increases, smokers also have several options available to minimize their expenditures for cigarettes (see Figure 1). Based on a compensatory model of price effects developed by investigators on the International Tobacco Control Policy Evaluation Project [20], unintended outcomes associated with a price increase are possible, including: (1) having no effect on the smokers’ behavior, (2) cutting back on cigarettes smoked, or (3) engaging in techniques to help alleviate the price burden. Previous literature has suggested that at least half of the decrease in cigarette demand occurs as a result of reductions in individual cigarette consumption, as opposed to complete cessation [1,7]. Although some evidence suggests that consumers have become more price sensitive over time [5,14], a recent IARC review has concluded that cigarette price elasticity has remained relatively stable over time and across different price levels in high income countries [13].

f1-ijerph-08-01671: Modified Compensatory Model of Price effects in response to a price or tax increase.

Mentions:
In addition to the intended cessation outcomes associated with price or tax increases, smokers also have several options available to minimize their expenditures for cigarettes (see Figure 1). Based on a compensatory model of price effects developed by investigators on the International Tobacco Control Policy Evaluation Project [20], unintended outcomes associated with a price increase are possible, including: (1) having no effect on the smokers’ behavior, (2) cutting back on cigarettes smoked, or (3) engaging in techniques to help alleviate the price burden. Previous literature has suggested that at least half of the decrease in cigarette demand occurs as a result of reductions in individual cigarette consumption, as opposed to complete cessation [1,7]. Although some evidence suggests that consumers have become more price sensitive over time [5,14], a recent IARC review has concluded that cigarette price elasticity has remained relatively stable over time and across different price levels in high income countries [13].

Bottom Line:
A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation.Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes.SES did not modify the effects of price minimizing behaviors on cessation outcomes.

ABSTRACTThis paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups.